God’s Hotel

Over at Books and Culture, a very thoughtful review is behind a paywall — but since you should subscribe to Books and Culture anyway, that shouldn’t be a problem, you know what I’m saying?

The book under review is God’s Hotel, by a doctor named Victoria Sweet. Here’s a description from Dr. Sweet’s website:

San Francisco’s Laguna Honda Hospital is the last almshouse in the country, a descendant of the Hôtel-Dieu (God’s Hotel) that cared for the sick in the Middle Ages. Ballet dancers and rock musicians, professors and thieves — “anyone who had fallen, or, often, leapt, onto hard times” and needed extended medical care — ended up there. Dr. Sweet ended up there herself, as a physician. And though she came for only a two-month stay, she remained for twenty years.

At Laguna Honda, lower-tech but human-paced, Dr. Sweet had the chance to practice a kind of “slow medicine” that has almost vanished. Gradually, the place and its patients transformed the way she understood the body. Alongside the modern view of the body as a machine to be fixed, her patients evoked an older notion, of the body as a garden to be tended. God’s Hotel tells their stories, and the story of the hospital, which — as efficiency experts, politicians, and architects descended, determined to turn it into a modern “health care facility” — revealed its truths about the cost and value of caring for body and soul.

A good deal of what Sweet has to say might strike a reader as fuzzy New-Agey stuff, but as Jonathan Hiskes explains in his review of the book, she provides a hard-headed analytical defense of the “slow medicine” she had a chance to practice at Laguna Honda, and in the process reminds us just how profoundly wrong our modern canons of “efficiency” can be, and how they rely on false economies:

Sweet’s journey alone would provide a worthwhile memoir. What gives God’s Hotel a dramatic arc, however, is the relentless determination of city-appointed efficiency consultants to turn Laguna Honda into a modernized hospital. They file report after report on the public hospital, forcing administrators to add layers of managers and thrusting more and more forms and training sessions at doctors and nurses, whose numbers are eventually cut. Sweet observes all this with candid skepticism. […]

She notes that health economists seek to conserve precious doctor time while allowing abundant lab tests and drug prescriptions. They also trim the hospital’s food budget down to a minimum, ignoring the central role diet plays in wellness. Sweet says they have things exactly wrong: It’s the tests and drugs that are exorbitantly expensive — well-used doctor time is cheap by comparison. She tells the story of a patient who waited three months to be discharged because his Medicaid-covered shoes hadn’t arrived. A fellow doctor met the patient, considered his medical duties, and drove to Wal-Mart to buy the man shoes, bucking bureaucratic protocol. “He must have saved the health-care system many thousands of dollars by buying those shoes, and yet [the consultants] would not have thought his action efficient,” says Sweet.

And near the end, Hiskes draws his thoughts together:

Sweet’s key insight is that by defining efficiency too narrowly, health care’s funders (i.e., all of us) end up paying much more. The question isn’t whether to be frugal. The question is whether discharging patients too quickly is more “efficient” than giving them time for rest and healthy eating under attentive care. The same risk holds true with overly narrow view of the “cost” of public education, public infrastructure, public social aid, and so on. She doesn’t belabor the point. Instead, she returns to the tension inherent in the limited resources that doctors and nurses face as they try to be agents of healing.

There seems to be one lesson that modernity never learns, indeed cannot learn while continuing to be modernity: the distant and abstract expertise of the bureaucrat cannot match the intimate local knowledge of the person who knows another person.